Download Predictors of 6-month major adverse cardiac events among 30

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Predictors of 6-month major adverse cardiac events among 30-day survivors after acute
myocardial infarction
Korea Acute Myocardial infarction Registry
*Jang Hoon Lee, Shung Chull Chae, Myung Ho Jeong, Young Keun Ahn, Jong Hyun Kim, Young Jo Kim, Seung Ho Hur, In Whan Seong,
Taek Jong Hong, Donghoon Choi, Myeong Chan Cho, Chong Jin Kim, Ki Bae Seung, Wook Sung Chung, Yang Soo Jang,
Jeong Gwan Cho, Seung Jung Park and other Korea Acute Myocardial infarction Registry Investigators
Background and Objectives: Little is known about the risk factors for major adverse cardiac events (MACE) at 6-month among 30-day
survivors of acute myocardial infarction (AMI). We investigated the predictors of MACE at 6-month among 30-day survivors after AMI in
the Korea Acute Myocardial Infarction Registry (KAMIR) patients. Methods: Between November 2005 and January 2008, 9837 eligible patients
(7065 males and 2772 females; mean age=64.0 ± 12.4 year-old) who survived more than 30 days after AMI were analyzed. The primary
end-point was 6-month MACE including death, MI, and revascularization. Results: During 6-month follow-up, 443 (4.5%) patients among
30-day survivors had MACE including 66 (0.7%) deaths, 77 (0.8%) MI, and 300 (3.0%) revascularization. The MACE increased with age,
and was more common in patients with shorter height, lower body weight, lower body mass index (BMI), renal dysfunction (serum creatinine
>1.5mg/dL), a history of ischemic heart disease, and a history of diabetes mellitus. In patients with MACE, heart rate and N-terminal pro-B
type natriuretic peptide (NT-proBNP) levels at baseline were higher, whereas left ventricular ejection fraction (LVEF) and total cholesterol
levels were lower than those without MACE. Patients who underwent percutaneous coronary intervention (PCI) had less MACE. In multivariate
logistic regression analysis, previous ischemic heart disease (odds ratio [OR] 4.03, 95% confidence interval [CI] 1.99 to 8.14, p<0.001),
log-transformed NT-proBNP (OR 1.36, 95% CI 1.04 to 1.77, p=0.022), and LVEF (OR 0.96, 95% CI 0.93 to 0.99, p=0.015) were independent
predictors of MACE at 6-month among 30-day survivors after adjustment of confounding variables. Conclusions: Previous ischemic heart
disease, log-transformed NT-proBNP levels, and LVEF are independent predictors of death, MI, or revascularization at 6-month among 30-day
survivors after AMI.
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Long-term clinical outcomes of definite very late
stent thrombosis after drug eluting stent implantation
인제대학교 부산백병원 심장내과1, 영남대학병원 심장내과2, 계명대학교 동산의료원 심장내과3
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*한양천 , 김두일 , 김기훈 , 설상훈 , 양태현 , 김성만 , 김대경 , 김동수 , 이원재 , 박종선 , 신동구 , 김영조 , 조윤경 , 남창욱 , 허승호 , 김권배
Background: Drug eluting stents (DES), by significantly reducing restenosis rates, have expanded indication of percutaneous coronary
intervention to complex lesions in high risk patients. But the advent of DES have raised concerns regarding later occurring stent thrombosis,
especially very late stent thrombosis (VLST). Little is known about occurrence of VLST and long term clinical outcomes after detection of
VLST Method: We retrospectively identified 19 patients with angiographicaly documented VLST which developed at least 1 year after DES
implantation. We assessed clinical and procedural data from them and evaluated the occurrence of long term major adverse cardiac events
(MACE). Results: The mean time to occurrence of VLST was 900 days (range, 379 to 1601 days). Discontinuation of anti-platelet drugs was
noted in 4 (21%) patients and average duration of discontinuation was 4 days (range, 2-5 days). Stent fracture was associated with VLST in
2 (10%) patients. Clinical presentations of VLST were myocardial infarction (17 patients, 89%) and silent ischemia (2 patients, 11%).
Percutaneous coronary intervention was the initial treatment strategy in all VLST patients. 12 patients (63%) were underwent balloon
angioplasty, 7 patients (37%) were underwent balloon angioplasty and stent implantation. Glycoprotein IIb/IIIa inhibitor was used in 6 (32%)
patients, thrombolytic agent was used in 2 (11%) patients. In 1 year clinical follow up after VLST, acute myocardial infarction was occurred
in 1 (9%) patient due to stent thrombosis, target vessel and target lesion revascularization was done in 2 (11%) patients. Total MACE was
occurred in 2 (11%) patients in 1 year clinical follow up. Conclusions: VLST after DES implantation was associated with significant adverse
clinical results. So, long time regular clinical follow up with intensive anti-platelet therapy might be needed.
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