목적 : 혈소판 혈전은 관상동맥 중재술 시술 중이나 직후에 일어나는 관상동맥의 급성 폐쇄와 같은 합병증을 일으키는데 주요한 역할을 하는 것으로 알려져 있다. 혈전내재 고위험 당뇨병 환자에서 관상동맥 중재술을 시술하는데 혈소판 당단백 IIb/IIIa 길항제인 ReoPro 의 유효성과 안전성 및 임상적 장기이득을 평가하고자 하였다.대상 및 방법 : 1999년 3월부터 2001년 2월까지 관상동맥 중재술을 시술 받았던 2231예 중 혈전내재 고위험 군으로 간주되어 ReoPro 를 사용하면서 관상동맥 중재 술을 시행하였던 환자 119예 (남자 90예, 여자 29예, 평균연령 59.1±10.8세), 152병변을 대상으로 하여, 당뇨병으로 진단된 30예 38병변을 I군 (남자 21예, 평균연령 57.7±8.2세), 당뇨병이 없는 89예 114병변을 II군 (남자 69예, 평균연령 59.6±10.8세)으로 하였다. 일차종결시점은 병원 내 사망, 심근경색증, 긴급 혈관재개통술 시행 등으로 평가하였고, 병원 내 출혈성 합병증 등을 조사하였다. 6개월 후를 이차 종결점으로 하여 평가하고 전체 기간 (18.5±6.7 (5∼28)개월) 중 주요 심장사건 등을 관찰하였다. 결과 : 1) 임상 진단명은 급성 심근경색증이 I 군 25예 (83.3%), II 군 76예 (85.4%)로 가장 많았고 관상동맥 질환의 위험인자는 고혈압 I 군 15예 (50.0%), II 군 31예 (34.8%), 고지혈증 I 군 8예 (26.7%), II 군 18예 (20.2%), 흡연 I군 14예 (46.7%), II 군 55예 (61.8%)로 차이가 없었다. 2) 병변의 ACC/AHA 분류상 B1형 I 군 10병변 (26.3%), II 군 38병변 (33.3%), B2형 I 군 17병변 (44.7%), II 군 38병변 (33.3%), C형 I 군 11병변 (28.9%), II 군 37병변 (32.5%)이었다. 3) 병원 내 MACE는 II 군에서만 8예 (9.0%)가 있었는데 사망 2예 (2.2%), 급성 심근 경색증 3예 (3.4%), 응급 관상동맥 중재술 1예 (1.1%), 관상동맥 우회술 2예 (2.2%)가 있었지만 유의성은 없었다. 출혈성 합병증으로 대출혈은 II 군에서 2예 (2.2%)가 관찰되었고 뇌출혈은 양 군 모두 없었다. 소출혈은 II 군에서 2예 (2.2%)있었으며 혈소판 감소증은 ReoPro 사용과 관련된 경우는 II 군에서 1예 (1.1%)있었으며 모두 보존적 치료로 호전되었다.

Background : High-risk percutaneous coronary interventions (PCI) are associated with high complication rate, low procedural success rate and high restenosis rate, especially in diabetics. We sought to observe whether diabetes affects long-term clinical outcomes after Abciximab (ReoPro) therapy in Korean patients undergoing high-risk PCI. Methods : One hundred nineteen patients with 152 lesion sites were administered ReoPro out of 2,231 patients who underwent PCI at Chonnam National University Hospital from Mar 1999 to Feb 2001. They were divided into two groups, 30 in diabetic group (Group I, 57.7±8.2 years, 22 male) and 89 in non-diabetic group (Group II, 59.6±10.8 years, 68 male). Early and long-term clinical outcomes after PCI were analyzed. Results : In clinical diagnosis the number of acute myocardial infarction was 25 in Group I (83.3%) and 76 in Group II (85.4%). As for risk factors and target lesion artery, ACC/AHA types, there were no differences between the two groups. The number of patients with total occlusion was 21 (55.3%) and 62 (53.9%) and thrombus-containing lesion 28 (93.3%) and 88 (98.9%) in Group I and II respectively. Procedure was successful in 27 (90.0%) in Group I and 80 (89.9%) in Group II and there were no differences in bleeding complications. No major adverse cardiac events (MACE), including myocardial infarction, repeat revascularization or cardiac death were observed in Group I, but there were 8 cases of MACE in Group II during hospitalization. Clinical follow-up was performed in 116 patients (97.5%) during 18.5±6.7 (5～28) months. The number of overall MACEs were 10 (3.3%) in Group I and 14 (15.7%) in Group II (p=0.038). Conclusion : ReoPro used in high-risk PCI in diabetics was effective in early clinical outcome, but long-term clinical benefits were not warranted.(Korean J Med 62:171-181, 2002)

Background : High-risk percutaneous coronary interventions (PCI) are associated with high complication rate, low procedural success rate and high restenosis rate, especially in diabetics. We sought to observe whether diabetes affects long-term clinical outcomes after Abciximab (ReoPro) therapy in Korean patients undergoing high-risk PCI. Methods : One hundred nineteen patients with 152 lesion sites were administered ReoPro out of 2,231 patients who underwent PCI at Chonnam National University Hospital from Mar 1999 to Feb 2001. They were divided into two groups, 30 in diabetic group (Group I, 57.7±8.2 years, 22 male) and 89 in non-diabetic group (Group II, 59.6±10.8 years, 68 male). Early and long-term clinical outcomes after PCI were analyzed. Results : In clinical diagnosis the number of acute myocardial infarction was 25 in Group I (83.3%) and 76 in Group II (85.4%). As for risk factors and target lesion artery, ACC/AHA types, there were no differences between the two groups. The number of patients with total occlusion was 21 (55.3%) and 62 (53.9%) and thrombus-containing lesion 28 (93.3%) and 88 (98.9%) in Group I and II respectively. Procedure was successful in 27 (90.0%) in Group I and 80 (89.9%) in Group II and there were no differences in bleeding complications. No major adverse cardiac events (MACE), including myocardial infarction, repeat revascularization or cardiac death were observed in Group I, but there were 8 cases of MACE in Group II during hospitalization. Clinical follow-up was performed in 116 patients (97.5%) during 18.5±6.7 (5～28) months. The number of overall MACEs were 10 (3.3%) in Group I and 14 (15.7%) in Group II (p=0.038). Conclusion : ReoPro used in high-risk PCI in diabetics was effective in early clinical outcome, but long-term clinical benefits were not warranted.(Korean J Med 62:171-181, 2002)

Platelets; Platelet aggregation; Diabetes; Acute Myocardial Infarction; Catheter- based coronary interventions