배경 : 혈소판 당단백질 IIb/IIIa 수용체 차단제인 Abciximab (ReoPro??)은 고위험 관상동맥 중재술의 결과를 향상시키고 주요 심장사건 감소에 효과적인 것으로서 관상동맥 중재술시 사용이 보편화 되어 있다. 급성 심근경색증을 동반한 70세 이상의 고령 환자에서 관상동맥 중재술시 ReoPro?? 투여의 임상 효과를 70세 미만의 환자와 비교하고자 하였다. 방법 : 2000년 1월부터 2002년 1월까지 관상동맥 조영술상 혈전을 내재하거나 혈전에 의해 완전폐쇄를 동반하는 급성 심근경색증으로 ReoPro?潁? 투여하면서 관상동맥 중재술을 받은 환자를 대상으로 70세 이상을 I군[74±2.4세, 28예(남 16예)], 70세 미만을 II군[56±8.0세, 122예(남 102예)]으로 분류하고 25±10.4개월의 추적관찰 기간동안의 주요 심장사건의 발생을 비교하였다. 결과 : (1) 성별이나 관상동맥 질환의 주요 위험인자에 있어서 양군간 차이는 없었다. (2) 병변혈관 수는 I군에서 단일혈관 15예(53%), 두혈관 11예(39%) 세혈관 1예(3%), II군 단일혈관 79예(64%), 두혈관 31예(25%), 세혈관 12예(9%)이었으며, ACC/AHA 분류상 I군에서 B1형 12예(42%), B2형 9예(32%), C형 7예(25%)였고, II군에서 각각 39예(32%), 44예(36%), 39예(32%)로서 차이는 없었다. TIMI 혈류는 TIMI 0 I군 16예(57%) II군 78예(63%), TIMI 1 I군 1예(3%) II군 13예(10%), TIMI 2 I군 8예(28%) II군 18예(14%), TIMI 3 I군 3예(10%), II군 13예(10%)로서 차이는 없었다. (3) 스텐트 시술은 I군 18예(64%), II군 78예(63%)에서 시행하였으며, 스텐트 길이는 각각 17.0±4.1 mm, 18.3±4.8 mm로서 차이는 없었다. (4) ReoPro?纓叢㈎? 관련된 출혈성 합병증에 있어서 위장관 출혈의 빈도가 I군에서 유의하게 높았다(p=0.005). (5) 1개월 내 단기 주요 심장사건의 발생은 심장성 사망이 I군에서만 3예(11%)로 I군에서 유의하게 높았으며(p=0.005), 급성 심근경색증과 응급 재관류술 및 응급 관상동맥 우회술이 II군에서 각각 3예(2%), 2예(1%), 2예(1%) 발생하였으나 양군간에 차이는 없었다. (6) 25±10.4개월간의 추적관찰 기간동안 사망 I군 3예(11%), II군 3예(2%), 심근 경색증 II군 4예(3%), 목표혈관 재개통술 I군 2예(7%), II군 24예(19%), 뇌졸중 II군 1예(0.8%) 발생하였으나 양군간의 차이는 없었다. 결론 : 관상동맥 중재술을 시행 받은 70세 이상의 고령의 급성 심근경색증 환자에서 ReoPro?榮? 70세 미만의 환자군에 비하여 출혈성 합병증의 위험을 증가시켰으며 조기 사망률을 낮추지는 못하였으나, 장기 임상경과에 있어서 유의한 차이가 없어서 효과적으로 사용될 수 있었다.

Background : This study was designed to evaluate the safety and clinical benefits of a glycoprotein IIb/IIIa receptor inhibitor, ReoPro?? in the elderly patients with acute myocardial infarction (AMI) (≧70 years of age) undergoing percutaneous coronary intervention (PCI). Methods : AMI patients who underwent PCI with use of ReoPro?? at Chonnam National University Hospital from Jan 2000 to Jan 2002 were divided into two groups: Group I (≧70 years of age: 74±2.4 years, n=28) and Group II (<70 years of age: 56±8.0 years, n=122). Early and long-term clinical outcomes after PCI were analyzed in a retrospective fashion. Results : As for risk factors and angiographic profiles, there were no differences between the two groups. Stenting was performed in 18 patients (64%) in group I and in 78 patients (63%) in group II. The incidence of gastrointestinal bleeding was 3 patients in group I and no patient in group II (p=0.005). At one-month evaluation, three cardiac deaths developed in group I, but no cardiac death in group II (p=0.005). During a period of 25±10.4 months of clinical follow-up, three cardiac deaths (11%) occurred in group I and 3 (2%) in group II, four AMIs (3%) in group II, and one stroke (0.8%) in group II. Target lesion revascularization (TLR) was performed in two patients (7%) in group I and in 24 patients (19%) in group II. No differences were found in the incidences of these variables between the two groups. Conclusion : ReoPro?? in elderly patients with AMI undergoing PCI entailed higher bleeding complications and early mortality. However, it has comparable clinical effect in elderly patients to younger patients during long-term clinical follow-up.

Background : This study was designed to evaluate the safety and clinical benefits of a glycoprotein IIb/IIIa receptor inhibitor, ReoPro?? in the elderly patients with acute myocardial infarction (AMI) (≧70 years of age) undergoing percutaneous coronary intervention (PCI). Methods : AMI patients who underwent PCI with use of ReoPro?? at Chonnam National University Hospital from Jan 2000 to Jan 2002 were divided into two groups: Group I (≧70 years of age: 74±2.4 years, n=28) and Group II (<70 years of age: 56±8.0 years, n=122). Early and long-term clinical outcomes after PCI were analyzed in a retrospective fashion. Results : As for risk factors and angiographic profiles, there were no differences between the two groups. Stenting was performed in 18 patients (64%) in group I and in 78 patients (63%) in group II. The incidence of gastrointestinal bleeding was 3 patients in group I and no patient in group II (p=0.005). At one-month evaluation, three cardiac deaths developed in group I, but no cardiac death in group II (p=0.005). During a period of 25±10.4 months of clinical follow-up, three cardiac deaths (11%) occurred in group I and 3 (2%) in group II, four AMIs (3%) in group II, and one stroke (0.8%) in group II. Target lesion revascularization (TLR) was performed in two patients (7%) in group I and in 24 patients (19%) in group II. No differences were found in the incidences of these variables between the two groups. Conclusion : ReoPro?? in elderly patients with AMI undergoing PCI entailed higher bleeding complications and early mortality. However, it has comparable clinical effect in elderly patients to younger patients during long-term clinical follow-up.

Platelets; Receptor; Acute Myocardial Infarction; Angioplasty