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ST 분절 상승 심근 경색 환자에서 증상 발생 후 풍선확장술까지 걸린 시간이 환자 예후에 미치는 영향

The influence of symptom to balloon time in ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

대한응급의학회지 2019년 30권 6호 p.577 ~ 583
천모세 ( Chun Mo-Se ) - 양산부산대학교병원 응급의학과

이대섭 ( Lee Dae-Sup ) - 양산부산대학교병원 응급의학과
민문기 ( Min Mun-Ki ) - 양산부산대학교병원 응급의학과
류지호 ( Ryu Ji-Ho ) - 양산부산대학교병원 응급의학과
이강호 ( Lee Kang-Ho ) - 양산부산대학교병원 응급의학과
이민지 ( Lee Min-Jee ) - 양산부산대학교병원 응급의학과
조영모 ( Cho Young-Mo ) - 부산대학교병원 응급의학과
김형빈 ( Kim Hyung-Bin ) - 부산대학교병원 응급의학과
왕일재 ( Wang Il-Jae ) - 부산대학교병원 응급의학과

Abstract


Objective: The current guidelines for the treatment of ST-segment elevation myocardial infarction (STEMI) recommends early reperfusion with a door to balloon (DTB) time of 90 minutes or less in patients undergoing primary percutaneous coronary intervention (PPCI). Therefore, the focus of most studies has been the DTB time. On the other hand, the ischemic time is related to the symptom to balloon (STB) time rather than the DTB time. This study examined the clinical effects of the STB time as well as the social and clinical factors affecting the STB time in STEMI patients.

Method: This study analyzed 286 patients diagnosed with STEMI from December 2008 to December 2016. The STB time (≤4 hours and >4 hours, ≤12 hours, and >12 hours) in the groups was compared. The mortality and ejection fraction were investigated. In addition, the characteristics of patients and socioeconomic factors affecting STB were analyzed.

Results: The SBT time is inversely associated with the ejection fraction (R=-0.126, P=0.033), and the ejection fraction of the ≤12 hours group was higher than that of the >12 hours group (54% vs. 50%, P=0.047). On the other hand, there was no significant difference in mortality between the two groups (3.26% vs. 4.84%, P=0.506). In multivariate analysis, the variable related to SBT was only typical chest pain (adjusted odd ratio, 1.931; 95% confidential interval, 1.014-3.792; P=0.045).

Conclusion: The results of the study support the prognostic value of SBT in STEMI undergoing PPCI. Therefore, efforts should be made to shorten the STB time.

키워드

Symptom to balloon time; Segment elevation myocardial infarction; Percutaneous coronary intervention
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