• 제목/요약/키워드: coronary revascularization

검색결과 112건 처리시간 0.03초

Clinical outcomes and characteristics of acute myocardial infarction patients with developing fever after percutaneous coronary intervention

  • Jae-Geun Lee;Yeekyoung Ko;Joon Hyouk Choi;Jeong Rae Yoo;Misun Kim;Ki Yung Boo;Jong Wook Beom;Song-Yi Kim;Seung-Jae Joo
    • Journal of Medicine and Life Science
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    • 제19권2호
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    • pp.46-56
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    • 2022
  • The incidence of fever complicating percutaneous coronary intervention (PCI) is rare. However, little is known regarding the cause of fever after PCI. Therefore, this study aimed to determine the clinical characteristics of patients with acute myocardial infarction (AMI), with or without fever, after PCI. We enrolled a total of 926 AMI patients who underwent PCI. Body temperature (BT) was measured every 4 hours or 8 hours for 5 days after PCI. Patients were divided into two groups according to BT as follows: BT<37.7℃ (no-fever group) and BT ≥37.7℃ (fever group). The 2 years clinical outcomes were compared subsequently. Fever after PCI was associated with higher incidence of major adverse cardiac events (MACE) (hazard ratio [HR], 1.56; 95% confidence interval [CI], 1.07-2.28; P=0.021), all-cause death (HR, 2.32; 95% CI, 1.18-4.45; P=0.014), cardiac death (CD) (HR, 2.57; 95% CI, 1.02-6.76; P=0.049), and any revascularization (HR, 1.69; 95% CI, 1.02-2.81; P=0.044) than without fever. In women, prior chronic kidney disease, lower left ventricular (LV) ejection fraction, higher LV wall motion score index, white blood cell count, peak creatine kinase-myocardial band level, and longer PCI duration were associated with fever after PCI. Procedures such as an intra-aortic balloon pump, extracorporeal membrane oxygenation, continuous renal replacement therapy, central and arterial line insertion, and cardiopulmonary resuscitation were related to fever after PCI. Fever after PCI in patients with AMI was associated with a higher incidence of MACE, all-cause death, CD, and any revascularization at the 2 years mark than in those without fever.

PET을 이용한 심근생존능의 평가 (Assessment of Myocardial Viability Using PET)

  • 윤석남
    • 대한핵의학회지
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    • 제39권2호
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    • pp.133-140
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    • 2005
  • The potential for recovery of left ventricular dysfunction after myocardial revascularization represents a practical clinical definition for myocardial viability. The evaluation of viable myocardium in patients with severe global left ventricular dysfunction due to coronary artery disease and with regional dysfunction after acute myocardial infarction is an important issue whether left ventricular dysfunction may be reversible or irreversible after therapy. If the dysfunction is due to stunning or hibernation, functional improvement is observed. but stunned myocardium may recover of dysfunction with no revascularization. Hibernation is chronic process due to chronic reduction in the resting myocardial blood flow. There are two types of myocardial hibernation: "functional hibernation" with preserved contractile reserve and "structural hibernation" without contractile reserve in segments with preserved glucose metabolism. This review focus on the application of F-18 FDG and other radionuclides to evaluate myocardial viability. In addition the factors influencing predictive value of FDG imaging for evaluating viability and the different criteria for viability are also reviewed.

좌주간지 병변에 대한 약물방출스텐트시술과 관상동맥우회수술의 1년 추적결과 비교 (Comparison of the One-year Follow-up Results after Coronary Bypass Surgery versus Percutaneous Coronary Intervention with Drug-eluting Stents in Patients with Left Main Coronary Artery Disease)

  • 최진호;임청;박계현;정의석;정우영;채인호;최동주
    • Journal of Chest Surgery
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    • 제41권2호
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    • pp.210-215
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    • 2008
  • 배경: 약물방출스텐트에 의한 재협착감소효과와 병행약물치료의 발달은 좌주간지병변에 대한 스텐트 시술의 증가를 가져오고 있다. 본 연구는 좌주간지병변에 대한 관상동맥우회수술과 약물방출스텐트 시술의 1년 임상성적을 비교하였다. 대상 및 방법: 본원에서 좌주간지병변으로 관상동맥우회수술이나 약물방출스텐트 삽입술을 받은 환자를 우회수술군과 스텐트군으로 나누어 이들 군의 수술 전 관상동맥질환 및 중증도, 입원기간, 원내 사망, 1년간 누적 사망 및 심근경색발생, 재관류술 시행비율 등을 비교 조사하였다. 결과: 101명의 관상동맥우회수술을 받은 환자(수술군)와 78명의 스텐트 시술을 받은 환자(스텐트군)가 분석대상이었다. 양군 환자의 연령, 성별, 위험인자, 좌심실 구혈률, 급성관 상동맥증후군의 비율에 있어서 차이가 없었다. 수술 군의 Euroscore가 $26.0{\pm}20.4$로 스텐트 군에 비해 높아 더 위험군이었으며(vs $6.38{\pm}10.31$, p<0.001), 긴급성도 37.6%로 더 많았으며(vs 10.3%, p<0.001) 입원기간도 16.1일로서 더 길었다(vs 7.9일, p=0.001). 좌주간지 이외 다혈관질환을 가지고 있는 경우도 수술군이 많았다(92.1% vs 37.2%, p<0.001). 원내 사망률과 1년 누적사망율에 있어서 차이가 없었다(3.0% vs 2.6%; 5.2% vs 6.6%, p=0.73). Euroscore로 matching한 41명의 수술환자와 78명의 스텐트환자를 선별하여 분석하였을 때 Euroscore (9.1 vs 6.4, p=0.104) 연령, 성별, 위험인자, 급성 관상동맥증후군의 비율의 차이는 없었다. Euroscore matched 분석에서 수술군에서 다혈관질환이 많았으며(87.8% vs 37.2%, p<0.001) 입원기간도 더 길었다(13.3일 vs 7.9일, p=0.02). 원내사망률과 1년 누적사망율은 수술군이 우수한 경향이 있었으나 통계적으로 유의하지는 않았다(0% vs 2.6%, p=0.55; 0% vs 6.6%, p=0.30). Euroscore matched 분석에서 1년 재관류술 비율은 스텐트군과 수술군에서 각각 13.3%와 6.3% (p=0.48), 사망 혹은 심근경색증 발생비율은 10.0%와 0% (p=0.09)였다. 결론: 저위험군 환자의 화주간지병변에 대한 약물방출스텐트 시술은 수술에 비해 입원기간 단축의 효과는 있지만, 추적관찰기간동안 재관류술 시행비율과 1년 누적 사망률이 증가하는 경향을 보이고 있으며, 보다 많은 환자를 대상으로 한 장기적 관찰이 필요하다.

관상동맥우회수술후 합병증과 사망율에 대한 임상적 고찰;61례 보고 (Complications amd Mortality After Coronary Artery Bypass Graft Surgery; Collective Review of 61 Cases)

  • 조건현
    • Journal of Chest Surgery
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    • 제26권7호
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    • pp.526-531
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    • 1993
  • Sixty-one consecutive patients with coronary artery bypass graft for myocardial revascularization were retrospectively reviewed to analyze various pattern of postoperative complication and death during hospital stay from Nov. 1988 to Oct. 1992. Fortytwo of the patients were male and nineteen female. The mean age was 56 and 51 years in male and female. Preoperative diagnosises were unstable angina in 14 of patients, stable angina in 28, postmyocardial infarction state in 15, and state of failed percutaneous transluminal coronary angioplasty in 4. 141 stenosed coronary arteries were bypassed with use of 20 pedicled internal mammary artery and 124 reversed saphenous vein grafts. Postoperative complications and perioperative death were as follows: 1. Of 61 patients undergoing operation, peri and postoperative over all complication occured in 15 patients [ 25% ]; newly developed myocardial infarction in 4, intractable cardiac arrhythmia including atrial fibrillation and frequent ventricular premature contraction in 3, bleeding from gastrointestinal tract in 2, persistent vegetative state as a sequele of brain hypoxia in 1, wound necrosis in 1, left hemidiaphragmatic palsy in 3 and poor blood flow through graft in 2. 2. Operative mortality was 8%[5 patients]. 3 out of these died in operating room; 1 patient by bleeding from rupture of calcified aortic wall, 1 by air embolism through left atrial vent catheter, 1 by low cardiac output syndrome. 2 patients died during hospital stay; 1 by acute respiratory distress syndrome with multiuple organ failure, 1 by brain death after delayed diagnosis of pericardial tamponade.

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관상동맥질환 치료를 위한 시롤리무스 방출 스텐트 ($CYPHER^{TM}$)의 경제성 분석 (Economic Value of the Sirolimus Eluting Stent($CYPHER^{TM}$) in Treating Acute Coronary Heart Disease)

  • 이후연;박은철;박기동;박지은;김영;이상수;강혜영
    • Journal of Preventive Medicine and Public Health
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    • 제36권4호
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    • pp.339-348
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    • 2003
  • Objective : To quantify the economic value of the Sirolimus fluting Stent ($CYPHER^{TM}$) in treating acute coronary heart disease (CMD), and to assist in determining an adequate level of reimbursement for $CYPHER^{TM}$ in Korea. Methods : A decision-analytical model, developed by the Belgium Health Economics Disease Management group, was used to investigate the incremental cost-effectiveness of $CYPHER^{TM}$ versus conventional stenting. The time horizon was five years. The probabilities for clinical events at each node of the decision model were obtained from the results of large, randomized, controlled clinical trials. The initial care and follow-up direct medical costs were analyzed. The initial costs consisted of those for the initial procedure and hospitalization, The follow-vp costs included those for routine follow-up treatments, adverse reactions, revascularization and death. Defending on the perspective of the analysis, the costs were defined as insurance covered or total medical costs (=sum of insurance covered and uncovered medical costs). The cost data were obtained from the administrative data of 449 patients that received conventional stenting from five participating Korean hospitals during June 2002. Sensitivity analyses were peformed for discount rates of 3, 5 and 7%. Since the major clinical advantage of $CYPHER^{TM}$ over conventional stenting was the reduction in the revascularization rates, the economic value of $CYPHER^{TM}$, in relation to the direct medical costs of revascularization, were evaluated. If the incremental cost of $CYPHER^{TM}$ per revascularization avoided, compared to conventional stenting, was no higher than that of a revascularization itself, $CYPHER^{TM}$ would be considered as being cost-effective. Therefore, the maximum acceptable level for the reimbursement price of $CYPHER^{TM}$ making the incremental cost-effectiveness ratio equal to the cost of a revascularization was identified. Results : The average weighted initial insurance covered and total medical costs of conventional stenting were about 6,275,000 and 8,058,000 Won, respectively. The average weighted sum of the initial and 5-year follow-up insurance covered and total medical costs of conventional stenting were about 13,659,000 and 17,353,000 Won, respectively. The estimated maximum level of reimbursement price of $CYPHER^{TM}$ from the perspectives of the insurer and society were $4,126,897{\sim}4,325,161$ and $4,939,939{\sim}5,078,181$ Won, respectively. Conclusion : By evaluating the economic value of $CYPHER^{TM}$, as an alternative to conventional stenting, the results of this study are expected to provide a scientific basis for determining the acceptable level of reimbursement for $CYPHER^{TM}$.

급성 심근 경색 후 협심증 환자에서의 관상동맥 우회술 후 좌심실 수축 기능의 호전 (Left Ventricular Systolic Function Improvement after Surgical Revascularization in Postinfarction Angina)

  • 이기종;박성용;홍유선;유경종;장병철;임상현
    • Journal of Chest Surgery
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    • 제39권9호
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    • pp.674-680
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    • 2006
  • 배경: 급성 심근경색증은 치사율이 높은 질환으로 일부 환자들에 있어서 수술은 중요한 역할을 한다. 본 연구에서는 급성 심근 경색증 후 협심증으로 수술을 시행 받은 환자들에서 심근벽 운동지수와 좌심실 박출계수의 변화를 통하여 수술 후 좌심실 수축력 변화를 조사하고자 하였다. 대상 및 방법: 2001년 1월부터 2004년 12월까지 급성 심근 경색증을 진단 받고 2주 이내에 수술한 환자들을 대상으로 하였다. 수술 전과 수술 후의 심근벽 운동지수와 좌심실 박출계수를 비교하였으며 이에 관련된 인자들을 조사하였다. 결과: 심근벽 운동지수는 $1.54{\pm}4.30$에서 수술 후 $1.43{\pm}0.40$ (p<0.001)으로 감소되었고, 좌심실 박출계수는 $48.1{\pm}12.2%$에서 $49.7{\pm}12.3%$ (p=0.009)로 호전되었다. 무심폐기하 관상동맥수술, 비 Q파 경색, 전벽(anterior) 경색과 경색 후 7일 이내 수술한 경우는 좌심실 박출계수 호전에 관계된 인자였다(p=0.046, p=0.006, p=0.003, p=0.005). 반면에 상기 인자들은 심근벽 운동지수의 호전과는 관계가 없었다. 삼혈관질환을 가진 환자들을 대상으로 하였을 때, 완전 재관류는 심근벽 운동지수 향상에 영향을 미치는 요소였다(p<0.001). 결론: 급성 심근경색증 환자들에 있어서 관상동맥 우회술은 심근벽 운동지수와 좌심실 박출계수의 호전을 가져오며 이는 좌심실 수축기능 호전의 근거로 설명될 수 있다. 특히 비 Q파 전벽성(anterior) 경색인 경우 7일 이내의 조기 수술은 좌심실 박출계수를 호전시키는 데 도움을 줄 것으로 생각되며, 완전 재관류는 심근벽 운동지수의 향상에 중요한 역할을 하는 것으로 생각된다.

First Results of the Single Heartstring Aortotomy for Multiple Off-Pump Vein Grafts: A Case Series

  • Santos, Rafael Freire dos;Niclauss, Lars
    • Journal of Chest Surgery
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    • 제53권6호
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    • pp.403-407
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    • 2020
  • To validate the technique of the single Heartstring aortotomy for multiple off-pump venous bypass grafts (described in 2015), the results of a 38-month follow-up study of 18 patients, including high-risk patients, are presented. No early deaths or cardiac or cerebral complications occurred. During the follow-up period, 2 patients died of non-cardiac causes, and 3 developed coronary ischemia. Ischemia occurred due to late graft occlusion in 2 patients, both of whom had normal postoperative courses and correct graft flow. The presence of acute symptoms 24 months after surgery in these patients indicated that technical graft failure was unlikely. This safe technique combines the advantages of simple and reproducible revascularization, the off-pump approach, and minimal aortic manipulation.

관상동맥 우회수술후 이식혈관의 개존 (Patency Rate of Grafts after Coronary Artery Bypass Surgery)

  • 노환규
    • Journal of Chest Surgery
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    • 제25권1호
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    • pp.42-48
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    • 1992
  • Clinical improvement after coronary artery bypass surgery depends on the complete revascularization and patency of graft vessels. Patency rate and the factors influencing the patency were studied by examining 134 grafts in 55 patients at a mean follow-up of 22.8$\pm$4.2 months, range 15 days and 108 months. Serial studies were performed on 7 patients with 18 grafts. The over-all patency rate was 80.6%, and the rate more than 5 years after surgery was 50.0% with mean interval of 81 months. Patency rate of patients who had taken both aspirin and dipyridamole was higher than of patients who had been treated with aspirin only[80.5% vs 56.5%]. The average serum triglyceride level of patients who had graft stenosis or occlusion in at least one site was significantly higher than that of patients in whom all grafts were patent[262.1mg% vs 174.8mg%]. Patency rate of grafts in patient who had angina was 73.2% and in patients without angina 79.2%. 6 patients underwent successful percutaneous transluminal angioplasty for narrowed or occluded grafts.

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관상동맥 우회술 91례의 임상적 고찰 (The Clinical Analysis of 91 Cases of Coronary Artery Bypass Graft)

  • 김학제
    • Journal of Chest Surgery
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    • 제28권5호
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    • pp.453-463
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    • 1995
  • During 42 month period 91 consecutive patient underwent coronary artery bypass surgery. The mean age of these patient was 57 years [range from 28 to 78 years . There were 57 men and 34 women. The preoperative risk factors that include beyond the 50 % of total patients were male sex, obesity, hypo-high-density lipoproteinemia, smoking, hypercholesterolemia, hyper-low-density lipoproteinemia, hypertriglyceridemia and hypertension. Preoperatively 27 patients had stable angina pectoris and 39 patients of unstable angina pectoris. Twenty five patients had previous myocardial infarction history. The patterns of disease were 8 patients of single vessel involvement, 18 patients of double vessel involvement, 54 patients of triple vessel involvement and 11 patients of left main coronary artery disease. Fifty five patients were in Canadian Cardiovascular Society functional class III. Myocardial revascularization was performed under emergency conditions in 5 patients. Nine percent of patients had previous PTCA history. We performed 16 cases of sequential anastomosis, internal mammary artery harvest in 86 percent of total patients and total 284 distal anastomoses[mean 3.1 anastomosis per patient . The mean ACC time was 60.5 minutes and ECC time was mean 110 minutes. The combined surgeries were 16 cases of endarterectomy, 2 cases of LV aneurysmectomy, 1 case of Bentall operation, 1 case of repair of sinus of Valsalva, 1 case of ligation of coronary AV fistula and 1 case of excision of breast mass. The most common complication was wound infection[12 cases, 13 % . There was one hospital death due to postoperative respiratory failure and low output syndrome in patient with postinfarction VSD, LV aneurysm. Postoperative 88 patients were in Functional class I or II. The 99mTc-MIBI myocardial perfusion scan that used as evaluation of postoperative state was well correlated with patient`s symptoms instead of some disadvantages.

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임공심폐기를 사용하지않는 관상동맥우회술 -1례 보고- (Coronary Artery Bypass Grafting without Cardiopulmonary Bypass -one case report-)

  • 나찬영;이영탁;김웅한;정철현;정윤섭;방정현;김욱성;이섭;한재진;정도현;정일상;박중원;박영관;홍승록;문현수
    • Journal of Chest Surgery
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    • 제29권11호
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    • pp.1267-1269
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    • 1996
  • 관상동맥우회술은 인공심폐기 및 심근보호의 안정성으로 인공심폐기사용하에 시행하는 것이 보편화된방법이다. 그러나, 좌전행지 및 우관상동맥에 병소가 위치하는 경우는 인공심폐기의 사용없이 심장이 박동하는 상태에서 관상동맥우회술을 시행하는 방법도 일부에서 시행되어왔다 저자들은 좌전행지 및 대각지에 협착을보인 환자에서 인공심폐기를 사용하지 않고 성공적으로 관상동맥우회술을 시행하였기에 보고하는 바이다.

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