저위험군의 불안정형 협심증 환자에서 B-Type Natriuretic Peptide와 장기 예후 = B-Type Natriuretic Peptide and Long-Term Prognosis in Low-Risk Patients With Unstable Angina

다국어 초록 (Multilingual Abstract)

Background and Objectives: In acute coronary syndrome (ACS), the B-type natriuretic peptide (BNP) level is a strong predictor of mortality. Most ACS patients have a history of myocardial infarction (MI) or high risk ACS, clinical entities that are anticipated to lead to elevated BNP levels. Therefore, we assessed the relationship between BNP levels and long-term prognosis in low-risk patients with unstable angina (UA). Subjects and Methods: Between September 2002 and June 2004, BNP was measured in baseline samples from 137 patients referred for angiography. UA was defined as a clinical diagnosis paired with significant coronary artery narrowing.
Patients had to exhibit no ST segment changes or abnormal Q waves, no elevation of cardiac enzymes, and no abnormal left ventricular diastolic or systolic function or regional wall motional abnormality on echocardiography.
Major adverse cardiac events (MACEs) were defined as cardiovascular death, MI, or readmission due to heart failure. Results: The mean patient age was 62.2±10 years, and 70 (51.1%) of the patients were men. The mean follow-up duration was 44.5 months. Six patients died due to cardiac causes, 4 were admitted due to heart failure, and 2 had MIs. The mean BNP level was not different between patients suffering MACEs and those not suffering MACEs. Other characteristics were similar between the groups. Kaplan-Meier survival curves showed a statistically significant benefit in the BNP ≤80 pg/mL group (p=0.037). There were no significant prognostic factors on multivariate analysis. Conclusion: A single BNP measurement was not an independent prognostic factor, but was related to event-free survival in patients with low-risk UA.

국문 초록 (Abstract)

요 약배경 및 목적급성 관동맥 증후군 환자의 예후를 예측하는 데 생화학적지표들이 유용한 것으로 알려져 있다. BNP는 급성 관동맥증후군에서 위험도를 계층화하고 장기 사망에 대한 강력한예후인자로서 유용성을 보고하고 있다. 하지만 저위험군의불안정형 협심증 환자에 대한 예후 인자로서 BNP의 중요성에 대한 보고는 아직 없었다. 이에 저위험군의 불안정형 협심증 환자에서 장기 예후 지표로서 내원시에 측정한 BNP의유용성을 평가하고자 하였다.
방 법2002년 9월부터 2004년 6월까지 허혈성 심질환으로 내원하여 관동맥 조영술을 시행 받고 50% 이상 협착이 동반된 환자 중 저위험군 불안정형 협심증 환자 139명을 대상으로 하여 주요 심장 사건 (심혈관 질환으로 인한 사망, 심근경색의 재발이나 심부전으로 인한 재입원)을 추적조사하였다. 불안정형 협심증은 ACC/AHA 치료 지침에 따른 불안정형 협심증 환자 중 관동맥 조영술상 50% 이상의 협착이 동반된 환자로 정의하였다. 저위험군의 정의는 심전도상 0.1 mV 이상의 ST 분절 하강이나 상승이 없고 비정상적인 Q파가 없으며, 심근 효소의 상승이 없는 환자로 정의하였다. 또한 심초음파상 좌심실 구혈률이 45% 미만이거나이완기 기능이 위정상 (pseudonormalized pattern), 제한형(restrictive filling)을 보인 환자와 신기능 장애를 가진 환자는 제외하였다.
결 과12명 (8.6%)의 환자에서 주요 심장 사건이 발생하였다. 주요 심장 사건이 발생한 군과 발생하지 않은 군 사이에 BNP 치에 통계적으로 유의한 차이는 없었으나 BNP치가 80 pg/ mL 초과군이 event free 생존율이 낮았다. 그러나 Cox proportional hazard regression 분석에서 주요 심장 사건의event free 생존율에 대한 독립적인 위험인자는 없었다.
결 론본 연구에서 내원시 측정한 BNP치는 저위험군 급성 관동맥 증후군 환자에서 주요 심장사건에 대한 독립적인 예후인자는 아니었지만 event free 생존율과 연관이 있었다.

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