Résumé
Background The benefit of statin use after acute ST-segment elevation myocardial infarction (STEMI) has been well established, however, the influence of the timing of statin administration has not been elucidated. The objective of this study focused on early clinical outcomes after percutaneous coronary intervention (PCI). Methods This analysis of the Korea Working Group on Myocardial Infarction registry (KorMI) study included 3,584 STEMI patients (mean age, 63 ±13 years;male, 2,684, 74.9%) undergoing PCI from January 2008 to June 2009. Rates of major adverse cardiac events (MACE:all-cause death, recurrent MI, and target lesion revascularization) were compared among patients grouped according to statin therapy timing:I, both during and after hospitalization (n=2,653, 74%);II, only during hospita-lization (n=309, 8.6%);III, only after discharge (n=157, 4.4%);and IV, no statin therapy (n=465, 13%). Mean follow-up duration was 234 ± 113 days. Results Multivariate factors of statin use during hospitalization included prior statin use, multiple diseased vessels, final thrombolysis in myocardial infarction flow grade III, and low-density lipoprotein cholesterol level. At 6-month follow-up, groups III and IV had the highest MACE rates (2.3%, 3.9%, 5.1%, and 4.9%for groups I-IV, respectively, P=0.004). After adjusting for confounders, groups II-IV had a higher MACE risk than group I [hazard ratio (HR):3.20, 95%confidence interval (95%CI):1.31-7.86, P=0.011;HR:3.84, 95%CI:1.47-10.02, P=0.006;and HR:3.17, 95%CI:1.59-6.40, P=0.001;respectively]. Conclusions This study, based on the national registry database, shows early and continuous statin therapy improvs early outcomes of STEMI patients after PCI in real-world clinical prac-tice.
Résumé
BACKGROUND: Color M-mode doppler echocardiography has been suggested as a new noninvasive technique for assessing left ventricular diastolic function. The present study was performed to define the feasibility and value of color M-mode echocardiography for the assessment of left ventricular diastolic function in patients with acute coronary syndrome. METHODS: Thirty six patients with acute myocardial infarcion and twenty three patients with unstable angina were included (M/F=41/18, 61+/-12.2 years). Doppler study was performed using ATL HDI-3000 within 24 hours after the attack. In color M-mode study, ROP was measured with 'Front wave method' and 'Baseline shift method'. The patients were grouped into three groups based on E/A ratio and deceleration time (DT) in transmitral flow and S/D ratio in pulmonary venous flow; Group I=Normal pattern (E/A>1, S/D>1, DT>140 ms), Group II=Impaired relaxation pattern (E/A140 ms) and Group III=Pseudonormal/Restrictive pattern (E/A>1.5, S/D0.05). CONCLUSION: The ROP seems not to reflect the diastolic function in acute coronary syndrome, although it is measurable with the 'Front wave method' in most cases. The measurement of the ROP with 'Baseline shift method' is not feasible in the patients with acute coronary syndrome.